Social Ties, Social Support And Emotional Distress Among Elderly In Rural Area

BACKGROUDEmotional distress always included depression, anxiety and suicide. The definition of emotional distress in this paper involved mood disorder and anxiety disorder which meet the criteria of DSM-Ⅳ, and serious symptoms which under the diagnosis criteria. Giving the high co-current with depression and sever health outcome, suicide is also considered to be a emotional distress. Emotional distress leads to large quantity burdens of disease. WHO reported in2000, depression is the4th top global disease burden. It may rise to the2nd top till2020. In China, major depression is take6.9%total disease burden in2000. It will be up to7.3%till2020. Suicide is the5th cause of death around the China. The peak of suicide rate is around the elderly. And the suicide rate in rural area is3-5times higher than which in urban districts. Emotional distress also mutually effected physical disease which may sharply decrease the quality of life. Sum all, emotional distress become an important public health issue.With good social tie is a major protect factor for emotional distress. Social tie refer to collection of all personal relationship. Social tie is the fundamental of social support. It also provide basic psychological need for individual, namely self estimate, belonging and care. Social tie also influence the health situation through the social influence and social role. Social isolation and social exclusion is the extreme status of social tie shortage. It may lead to sever health problem such as depression and suicide. During the elderly period, social ties decrease gradually due to the physical disease and spouse passed away. Giving the social tie is a important protective factors for emotional distress, decrease of social tie is a major challenge for aged people.To explore in this field is hindered by using self rate health report, dispute about the concept and less screen tool could be used.OBJECTIVEThe objective of this research is to picture the situation of emotional distress among the eldery in rural area; to compile a tool for social ties' evaluation and analyse the correlation between social ties and emotioal distress; to explore the correlations between emotional distress and major effect factors namely physical disease, activity ability, life events and social ties; to familiar with the help seeking behavior among the patients with major depression; and to provide scientific prevention model targeting at decreasing emotional distress among elderly in rural areas by improving the social ties based on the results of this research.METHODThe subjects of this study is residents who was no less than60years old and living no less than6months in rurual areas of Liuyang. Multistage clustered random sampling was adotped and8natural villages was selected as frame of samples. Emotional distress is evaluated by SCID, PHQ9, GAD7and Suicide screening scale. The activity ability was evaluated by ADL (Activity of Daily Life); The incidence of life evets was evaluated by LESE (Life Events Scale for the Elderly);Social ties was evaluated by self made scale with five dimesions namely spouse, child, friend, neigbor and social participation. Help seeking behavoir among patients with major depression in one year follow up study was evaluated by self made scale.RESULTThere are941induviduals meeting the enrolling cretiera and839 individuals completed the investigation. The response rate is89.16%. There is no significant difference between the lost group and completed group in gender and age. Among the839individuals who completed the interview, there are448(53.4%) males and media age is68years old (QR=13,P25=63, P75=76).Among the839individuals, the prevalence of emotional distress is17.0%(95%CI15.3%-20.4%). The prevalence of Major depression, depression symptoms, anxiety symptom, suicide ideation and suicide attempt are6.8%(95%CI5.1%-8.5%),12.8%(95%CI10.5%-15.0%),7.4%(95%CI5.6%-9.2%),5.6%(95%CI4.0%-7.2%) and0.8%(95%CI0.2%-1.5%) separately. The result of multiple logistic regression analysis indicate that with increasing of annual income, the prevalence of emotional distress decreased.Five dimensions of social ties was evaluated by marrital status, living arrangement, number of friends, relationship of neighbors and times participating the group activities. The indicators of these five dimensions reflecte the situation of social ties objectively and truly, and correlated with emotional distress. Social support as a criterion-related validation middle level correlated to social ties (r=0.588).The results of multiple logistic regression analysis indicate that physical disease (adj OR=2.203,95%CI:1.335-3.633), lower activity ability (adj OR=6.564,95%CI:3.332～12.932), negative life events (adj OR=1.143,95%CI:1.090～1.198) are risk factors of emotional distress. Adequate social ties (adjOR=0.743,95%CI:0.656～0.985) are protect factors of emotional distress. Social ties and negative life events have interaction on influence of emotional distress.One year follow up study find out that there is no one seeking the professional help in the past year among patients with major depression. CONCLUSION1. Prevalence of emotional distress among the investigated area is17.0%(95%CI15.3%-20.4%). Among them, The prevalence of Major Depression, Depression Symptom Anxiety Symptom, Suicide Ideation and Suicide Attempt are6.8%(95%CI5.%1-8.5%),12.8%(95%CI10.5%-15.0%),7.4%(95%CI5.6%-9.2%),5.6%(95%CI4.0%-7.2%) and0.8%(95%CI0.2%-1.5%) separately. Individual annual income is significantly effect emotional distress.2. Physical disease, activity ability, life events and social ties are major effect factors of emotional distress. Social ties and life events have interaction on influence of emotional distress. There are highest risk of emotional distress when negative life events and poor social ties coexisted.3. The social ties are clearly defined in this research and inclued five dimensions, spouse, child, friends, neighbors and social participation. The method of evaluation on social ties was formed basing on the definition. The results of the research indicated that the results reflects social ties objectly and truly, and middle level related to social supprt and negatively related to emotional distress. The definition fits the hypothesis of social tie.4. During an one year follow up period, there is no one has visited the doctors among the patient with Major depression.